If a girl has suffered from anorexia nervosa, by definition she has had trouble with her body's reproductive hormones. The body's response to scarcity is the connection between weight loss and infertility. Women evolved to stop reproducing in times of famine.
Biochemically, the body responds to a deficit of calories or nutrition by ratcheting up or down chemicals that affect the brain, the appetite, and the reproductive system. The whole system centers on a trio of body organs that orchestrate fertility: the ovaries, the pituitary gland, and a region of the brain called the hypothalamus. At birth, a woman's lifetime of eggs are formed and wait, potent, in her ovaries. Puberty arrives. Normally, the eggs mature and send out waves of body chemicals, including estrogen and progesterone.
The hormones ebb and flow monthly. Their fluctuation activates the hypothalamus, a peach pit–shaped structure at the base of the brain. The hypothalamus then signals the pituitary gland to prod the ovaries to ripen and release an egg every month. The hypothalamus has a second function: it is a food and energy sensor. In times of scarcity, the hypothalamus senses that energy input is low. To rebalance the body, it unleashes chemicals that interfere with reproduction in order to conserve energy. Evolution is speaking: What species would want to give birth in times of famine?
Meanwhile, body fat stores estrogen. In anorexia nervosa, body fat is metabolized and so are estrogen reserves, causing further problems with reproductive feedback circuitry. Exercise boosts stress hormones such as cortisol and suppresses a fat-regulating hormone called leptin. If these hormones remain altered for too long, as they can be in states of chronic overexercise, they also interfere with the hormones controlling the ovaries, hypothalamus, and pituitary.
A dangerously low caloric input causes the hypothalamus and other regions of the brain to alter the production of neurotransmitters such as serotonin, which influence reward centers - appetite and mood, the building blocks of libido. This is the basic science about how long-term disordered eating and overexercise cause a woman to lose her periods and sex drive. A woman with anorexia is not going to get pregnant without medical help. And she may want it to be this way.
While she is probably not waking up each morning and saying, "I do not want to get pregnant, so I'd better starve myself today," on a deeper level, by committing to anorexia, she is forgoing her chance to have a baby. Whether the reasons for these behaviors are conscious or subconscious, the message is clear: some women with anorexia are using infertility to sidestep confrontation with motherhood.
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